Are blood tests necessary for treatment?

There is no need to have any routine blood tests before starting gender-affirming hormone therapy with the following exceptions:

  1. If you are going to take spironolactone we need a Kidney Function Test (U&E's including potassium test) and a blood pressure reading. 
  2. If you are going to take cyproterone acetate or bicalutamide we need a full health check (Full Blood Count (FBC); Kidney Function Test (U&E); Liver Function Test (LFT); Diabetes (HbA1C); Cholesterol (Lipids); and blood pressure reading).
  3. If you are going to take testosterone it may be useful to have a baseline test for haematology (how many red blood cells you have in the blood) prior to starting. This may help if your haematocrit comes back high after starting testosterone, but is not essential. Haematocrit is higher when you have testosterone than when you have oestrogen, so we expect it to increase on testosterone treatment. (This test is optional and the patient can choose whether or not to have it done).

However, it is really important that regardless of gender-affirming care that you keep healthy and we recommend that everyone has a routine health check with their doctor when needed, but this does not affect your ability to start gender-affirming hormones.


Our recommendation is that everyone who is aged 40 to 74 who does not have any of the pre-existing conditions listed below should have a health check every 5 years.

If you do suffer from any of the conditions listed below you should already be having regular check-ups.

Your own doctor will be able to give you more information about this.

  • heart failure
  • heart disease
  • atrial fibrillation
  • previous checks have found that you have a 20% or higher risk of getting cardiovascular disease over the next 10 years
  • deep vein thrombosis
  • high blood pressure (hypertension)
  • stroke
  • transient ischaemic attack
  • chronic kidney disease
  • diabetes
  • peripheral arterial disease
  • inherited high cholesterol (familial hypercholesterolemia)
  • currently being prescribed statins to lower cholesterol